Transition from Synthroid to NDT

[Frankie777]

I am transitioning from synthetic to natural thyroid replacement.  I had thyroid cancer so I'm on suppresion dose.  I have to admit after three weeks I am not feeling well at all and I'm a bit panicked because I really wanted the natural to work and "cure" all my issues that have occured since going on the Synthroid.  It has been an 18 month fight with 5 different doctors.  I finally found one that is listening and did a full blood panel.  However, I'm having strange symptoms that I've never had before?  They checked my adrenals so I don't believe it is that.  I asked the doctor what I should expect in the transition and she said no side effects should be felt and I should just feel better but I'm not sure she is correct.  Has anyone else had issues changing from one to another??  I called the doctor today and their office is closed until 01/06/14 for the holiday.

[gimel]

Be aware that there are different recommendations for equivalent amounts of NDT to T4.  In one place you can read that one grain of NDT is equivalent to 100 mcg of T4.  In another place it states that one grain is equal to only 75 mcg of T4.  My own experience is that I would go with the one grain for each 75 mcg of T4.  

This is not so important if your doctor is adjusting your med as necessary to relieve symptoms.  That is what a good thyroid doctor does, rather than just going by lab test results.  

[fddlr2]

I am going to make the switch to NDT soon too so I have been reading up on it.  Here is what I have learned.  Yes it is good to split the dose between morning and afternoon.  Make sure you wait at least 4 hours after your last meal and 1 hour before your next meal and don't take with birth control, iron or calcium.  Also, be sure to stop taking your NDT at least 12 hours before your lab tests as it will give an unusually high reading to your T3 and your doctor and you will freak out!  Best of luck.

[Frankie777]

I only took half the dose this morning and will take the other this afternoon.  It makes sense that could level out symptoms.  Thank you for your time and responses.

[gimel]

Your Vitamin D, and your ferritin/iron levels are good.  Your B12 is lower than desirable, but you are starting on supplement to raise that level.  Your Free T4 level was higher than necessary, due to the large dose of T4 med you were taking.  Even that dose did not get your Free T3 to a level that works for most hypo patients, due to inadequate conversion of the T4 to T3.  that is a common occurrence for hypo patients.  

So a switch to NDT was the right move.  Unfortunately the switch was not done correctly.  Your dose of T4 averages out to about 157 mcg daily.  There are basically two sets of recommended conversions from T4 to NDT.  One says that one grain of NDT is equal to 100 mcg of T4.  That is apparently what your doctor utilized.  Another conversion table lists a grain of NDT as being equal to 75 mcg of T4.  So, I expect that you were shortchanged a bit in the conversion, and will need to gradually increase your dosage in order to get your Free T3 high enough to relieve symptoms, which is what it is all about.  

I think it would have been better to transition to the new med/dose in a couple of steps, rather than all at once.  Since you have been taking the new med/dose for about 3 weeks, that is no longer a consideration.  

Another concern is that you were not directed to split your dose of NDT in half and take in the morning and early afternoon.  T3 acts so much faster than T4, that splitting the dose tends to even out the effect through the day.  I expect that taking it all  at once is contributing to your reactions.  So, I suggest that you should split the dose in half and take 1/2 in the morning and 1/2 in the afternoon, and see how you feel with that.  

I also suggest that you should shortly go back and get re-tested to see what your Free T3 and Free T4 levels are currently.  If you are still having symptoms, and your Free T3 is in the lower half of the range, it would indicate the need to gradually increase your dosage as necessary to relieve symptoms.  Of course that needs to be discussed and agreed upon with your doctor.    

[Frankie777]

Yes, entire dose is taken in the morning.  Nothing for one hour after and no meds or supplements for 4 hourse after.

[gimel]

One further question occurred to me while pondering your info.  Are you taking all your Armour Thyroid at once in the morning??

[Frankie777]

Levo dose:  150mcgX5/week and 175mcgX2/week
Armour:  90mg (1.5GR) daily

Symptoms:  shakiness, radical emotions/mood swings, short of breath, sensitive to stimulants (coffee, Sudafed, sugar, etc.) anxiety, racing thoughts, overwhelmed, elevated heart rate usually noticable starting around 4 pm and continues until 10-11 pm then drops.  My Dr. told me to monitor my resting heart rate so I have been taking my pulse.  She said if there is a 10 point difference between morning and evening I'm at risk for a stroke.  It has been steadily increasing and now the last 3 days it has been at a 10-14 point difference.

Positves so far:  energy is back, able to stay on my feet and do housework without pain and soreness the next day, I can stay in a position without muscle weakness rapidly occuring, I can be emotional but I am also feeling joy and gratitude again.

I'm assuming these are symptoms of being hyper but I'm just not sure if the dose isn't right or if I'm one of those who is going to struggle getting this dialed in??   My fear is the Dr. will take me off of NDT because I cannot get to suppression without giving myself a heart attack!

I was reading that you are supposed to transition to a low dose of Armour not your target dose that equals your synthetic.  Is that true?  Out of fear and not being able to contact my doctor I cut my pill in half this morning.  I'm sure that will have it's consequences too but I feel like I'm back to square one when I started with the TT and Synthroid - completely confused and feeling like yuck.  So I'm playing doctor out of fear that my heart rate is too high.

Labs:
FT4 1.7 (0.8-1.8)
FT3 2.8 (2.3-4.2)
TSH 0.27 ((0.40-4.50)
Iron Total 54 (40-450)
Iron Binding Capacity 404 (250-450)
Ferritin 80 (10-232)
Vit D 69 (30-100)
Vit B12 391 (200-1100) - Dr. put me on 1000 mg / day
DHEA Sulfate (Adrenals) 152 (25-220)
Had two Parathyroids removed, two remaining are damaged
Parathyroid Hormone 3 (10-65)
I supplement heavily with Calcitriol and Vit D3 (50,000IU/day)
Calcium is 9.8 (8.6-10.2) was told to back down the supplements from 3000 mg to 1000 mg ( I am still taking 2000 mg however, I started to get the facial ticking back on 1000mg)

Any of your experienced advice would be great.  I know this is an age old issue of switching from synthetic to NDT but new to me:)

Thank you!

[gimel]

What was your dosage of T4?  What is your dosage of NDT?  what symptoms are you having?  

Please post any thyroid related test results you have, along with reference ranges shown on the lab report.  Also, if tested for Vitamin D, B12 and ferritin, please post those, and their ranges, as well.